Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6337 | IA |
NPI | 1003952649 |
---|---|
Provider Name | Dr. Donna D Pipho |
First Address | La Porte City, IA 50651 |
Second Address | La Porte City, IA 50651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0152001 | (05) | IA |
15280 | WELLMARK BCBS OF IOWA (01) | IA |
42110449900001 | BLUE DENTAL (01) | IA |